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Biomedical subjects

P J Dolin

Publications and source records attributed to P J Dolin.

At least 19 recordsLinked to original sources
PubMed2001

The management of chronic pain in Switzerland: a comparative survey of Swiss medical specialists treating chronic pain.

Chronic pain management by Swiss specialist physicians with the primary hypothesis that pain clinic practitioners conform better to good practice (interdisciplinarity, diagnostic/therapeutic routines, quality control, education) than other specialists treating chronic pain was surveyed. Management of all types of chronic pain by pain clinic practitioners and rheumatologists, oncologists or neurologists was compared via a mailed questionnaire survey (n=125/group). Two hundred and twenty-nine (46%) of 500 mailed questionnaires were returned with similar group return rates. Eighty-six percent of responders find chronic pain therapy very difficult/difficult; they estimate only 45% of these patients achieve good outcomes. Twenty-three per cent of responders belong to an interdisciplinary pain centre, but 72% of chronic pain patients are treated by responders alone. Fifty-nine percent never/only occasionally use therapeutic algorithms, 38% use formal pain diagnostic procedures, 20% have a pain quality control programme. Fifty-one percent lack past pain education, 37% do not attend continuing pain education, 69% agree that pain education is their greatest need. Pain clinic practitioners are more interdisciplinary and use more pain diagnostics than other specialists. They are matched by oncologists in education and success in therapeutic escalation, and bettered by them in algorithm use. Pain clinic practitioners and oncologists bring particular-differing-skills to chronic pain management compared to rheumatologists and neurologists. Chronic pain management diversity may result from differences in malignant and benign pain, and its generally being provided by the speciality treating the underlying cause. This survey identifies targets for improvement in areas fundamental to good chronic pain practice: interdisciplinarity, diagnostic/therapeutic tools, quality management and education.

Algorithms↗
PubMed2000

Evaluation of a national eye care programme: re-survey after 10 years.

AIM: To re-survey the Gambia after an interval of 10 years to assess the impact of a national eye care programme (NECP) on the prevalence of blindness and low vision. METHOD: Comparison of two multistage cluster random sample surveys taking into account the marked increase in population in the Gambia, west Africa. Samples of the whole population in 1986 and 1996 were taken. The definition of blindness is presenting vision less than 3/60 in the better eye, or visual fields constricted to less than 10 degrees from fixation. Low vision is less than 6/18 but 3/60 or better. Causes of blindness were determined clinically by three ophthalmologists. RESULTS: The crude prevalence of blindness fell from 0.70% to 0.42%, a relative reduction of 40%. During the same 10 year period, the population increased by 51% from 775 000 to 1 169 000. When the results were standardised for age, a west to east gradient was found for changes in risk of blindness over the 10 year period. This matched the phased west to east introduction of the NECP interventions. There was a modest but significant increase in the risk of low vision across the whole country. CONCLUSIONS: The overall reduction in risk of blindness, in those areas where the NECP has been active, appears to justify the programme and the support of donor organisations. The low vision cases due to cataract must now be addressed.

Blindness↗
PubMed1999

Modelling uveal melanoma.

BACKGROUND/AIM: There has been no consistent pattern reported on how mortality for uveal melanoma varies with age. This information can be useful to model the complexity of the disease. The authors have examined ocular cancer trends, as an indirect measure for uveal melanoma mortality, to see how rates vary with age and to compare the results with their other studies on predicting metastatic disease. METHODS: Age specific mortality was examined for England and Wales, the USA, and Canada. A log-log model was fitted to the data. The slopes of the log-log plots were used as measure of disease complexity and compared with the results of previous work on predicting metastatic disease. RESULTS: The log-log model provided a good fit for the US and Canadian data, but the observed rates deviated for England and Wales among people over the age of 65 years. The log-log model for mortality data suggests that the underlying process depends upon four rate limiting steps, while a similar model for the incidence data suggests between three and four rate limiting steps. Further analysis of previous data on predicting metastatic disease on the basis of tumour size and blood vessel density would indicate a single rate limiting step between developing the primary tumour and developing metastatic disease. CONCLUSIONS: There is significant underreporting or underdiagnosis of ocular melanoma for England and Wales in those over the age of 65 years. In those under the age of 65, a model is presented for ocular melanoma oncogenesis requiring three rate limiting steps to develop the primary tumour and a fourth rate limiting step to develop metastatic disease. The three steps in the generation of the primary tumour involve two key processes-namely, growth and angiogenesis within the primary tumour. The step from development of the primary to development of metastatic disease is likely to involve a single rate limiting process.

Adult↗
PubMed1998

Epidemic optic neuropathy in primary school children in Dar es Salaam, Tanzania.

BACKGROUND: An epidemic of bilateral optic neuropathy is affecting large numbers of people aged between 10 and 40 in Dar es Salaam, the capital city of Tanzania. The disease is characterised by acute onset of bilateral visual impairment, bilateral impairment of colour vision, and a characteristic temporal pallor of the optic discs. The disease often occurs in association with peripheral neuropathy and sensorineural hearing loss. This report presents the first data on disease prevalence in adolescents, based on a rapid assessment of schoolchildren. METHODS: Three schools in Dar es Salaam were visited and all children aged between 10 and 16 were screened for the disease. RESULTS: The prevalence of bilateral optic neuropathy among the schoolchildren is estimated to be 1.0% (95% CI 0.5-1.4%). This suggests that 5000 children (95% CI 2600-7300) aged 10-16 in Dar es Salaam may have the disease. CONCLUSION: The results of this rapid assessment indicate this epidemic is a major public health problem. The prevalence of the disease in the community is likely to be far higher than found in this survey because children with the disease may have withdrawn from school. As the disease predominantly affects young adults, resulting in impaired vision and hearing, the economic and social consequences are enormous.

Adolescent↗
PubMed1998

Trachoma in The Gambia.

BACKGROUND: As part of the second National Survey of Blindness and Low Vision in the Gambia carried out in 1996, all survey participants were examined for signs of trachoma. The findings were compared with the results of the first survey in 1986, which used the same sampling strategy. METHODS: A multistage stratified cluster random sample, with proportional probability sampling, was obtained. Stratification included settlement size (less than 400 residents, and 400 and more residents). All subjects were examined for trachoma using the simplified WHO grading system. RESULTS: Of the sample of 14,110 people, 13,047 (92.5%) were examined. Active inflammatory trachoma (grade TF or TI) was found in 3.0% of all age groups and 5.9% of children aged 0-9 years old. Trichiasis was found in 3.3% and trachomatous corneal opacities in 0.9% of adults aged 30 and over. The prevalence of blinding trachomatous corneal opacities was 0.02%, compared with 0.10% 10 years previously. CONCLUSION: Compared with a previous national survey undertaken in 1986, prevalence of active trachoma has fallen by 54%. There has been an 80% relative reduction in blinding trachomatous corneal opacities over the 10 year period.

Adolescent↗
PubMed1997

Reduction of trachoma in a sub-Saharan village in absence of a disease control programme.

BACKGROUND: Trachoma is a leading cause of blindness in the developing world and is most prevalent among people who live in poor rural communities in arid locations. METHODS: We analysed the results of surveys of trachoma prevalence in Marakissa, a rural village in The Gambia. These surveys were undertaken in 1959, by the Medical Research Council, and in 1987 and 1996 by the Gambian National Eye Care Programme. FINDINGS: During this 37-year period, the prevalence of active inflammatory trachoma among children aged 0-9 years fell from 65.7 cases per 100 children in 1959 to 2.4 cases per 100 children in 1996. The prevalence also fell dramatically among people of 10-19 years (52.5 to 1.4 per 100) and among people of 20 years and older (36.7 to 0 cases per 100). INTERPRETATION: The dramatic fall in disease occurrence was paralleled by improvements in sanitation, water supply, education, and access to health care in the village. Of particular importance is that the decline in trachoma occurred without any trachoma-specific intervention.

Adolescent↗
PubMed1996

Trends in eye cancer mortality among adults in the USA and England and Wales.

Trends in eye cancer mortality are presented for the USA and England and Wales during the period 1955-89. Mortality rates have fallen by 58% in the USA during this period. The fall in mortality is paralleled by an equal fall in incidence rates in the USA. In England and Wales, mortality rates and incidence rates have remained relatively constant during the last three decades. The explanation for these differences between the USA and England and Wales is unknown.

Age Factors↗
PubMed1995

Mortality before and after HIV infection in the complete UK population of haemophiliacs. UK Haemophilia Centre Directors' Organisation.

During 1977-91, 6,278 males diagnosed with haemophilia were living in the UK. During 1979-86, 1,227 were infected with the human immunodeficiency virus (HIV-1) as a result of transfusion therapy (median estimated seroconversion date, October 1982). Among 2,448 with severe haemophilia, the annual death rate was stable at 8 per 1,000 during 1977-84; during 1985-92 death rates remained at 8 per 1,000 among HIV-seronegative patients but rose steeply in seropositive patients, reaching 81 per 1,000 in 1991-92. Among 3,830 with mild or moderate haemophilia, the pattern was similar, with an initial death rate of 4 per 1,000 in 1977-84, rising to 85 per 1,000 in 1991-92 in seropositive patients. During 1985-92, there were 403 deaths in HIV seropositive patients, whereas 60 would have been predicted from rates in seronegatives, suggesting that 85% of the deaths in seropositive patients were due to HIV infection. Most of the excess deaths were certified as due to AIDS or to conditions recognized as being associated with AIDS.

Adolescent↗
PubMed1994

Paraplegia and squamous cell carcinoma of the bladder in young women: findings from a case-control study.

A death certificate-based case-control study was conducted on 207 women aged 25-44 who died of bladder cancer in England and Wales in the period 1971-89 and 411 controls matched on sex, year of death and age at death. An odds ratio of 12.0 (95% CI 1.5-99.7) was found for women with a history of paraplegia. Four of the six paraplegic women were reported to have had squamous cell carcinoma of the bladder compared with only 19 of the 201 non-paraplegic women. These findings suggest that squamous cell carcinomas of the bladder, especially in paraplegics, may be the result of chronic urinary tract infection.

Adult↗
PubMed1994

Solar ultraviolet radiation and ocular disease: a review of the epidemiological and experimental evidence.

Exposure to solar ultraviolet radiation has been linked, at some point, with more than a dozen eye diseases. Some of these associations are based solely on anecdotes, while others have been subjected to epidemiological investigations. For each eye disease, the evidence for an association with ultraviolet radiation is presented and evaluated. The only eye disease for which there is sufficient evidence of a causal association in humans is photokeratitis. For several eye diseases (climatic droplet keratopathy, pterygium, cataract) there is limited evidence for an association, while for other diseases (uveal melanoma, macular degeneration) there is either little support for an association or inadequate data on which to base an assessment.

Animals↗
PubMed1994

Methodological considerations for future epidemiological studies of solar ultraviolet radiation and eye disease.

This paper reviews current methodological and epidemiological issues that face researchers interested in examining the relationship between exposure to solar ultraviolet radiation and cataract and other eye diseases. Key areas addressed include study design, measurement of ocular exposure, potential confounding and modifying factors, and evaluation of the impact of ozone depletion on eye diseases.

Animals↗
PubMed1994

Uveal melanoma: is solar ultraviolet radiation a risk factor?

Age-standardized mortality rates for cancers of the eye among adults in England and Wales are compared with those for cutaneous malignant melanoma. While cutaneous malignant melanoma rates have increased three-fold since 1950-54, rates for cancers of the eye have remained relatively constant over the same period. Collectively, the inconclusive findings of case-control studies for an association between exposure to ultraviolet radiation and uveal melanoma, the lack of supporting dosimetry data, together with the lack of an upward trend in mortality rates for cancers of the eye, suggests that exposure to ultraviolet radiation may not be a major factor in the etiology of uveal melanoma.

Adult↗
PubMed1994

Global tuberculosis incidence and mortality during 1990-2000.

Forecasts of tuberculosis morbidity and mortality are presented for the decade 1990-99. An estimated 88 million new cases of tuberculosis, of which 8 million will be attributable to HIV infection, will occur in the world during the decade; 30 million people are predicted to die of tuberculosis in the same period, including 2.9 million attributable to HIV infection. The number of new tuberculosis cases occurring each year is predicted to increase from 7.5 million (143 cases per 100,000) in 1990 to 8.8 million (152 per 100,000) in 1995 and 10.2 million (163 per 100,000) in the year 2000. In 1990, 2.5 million persons were estimated to have died of tuberculosis; at the same level of availability of treatment, it is predicted that 3.0 million tuberculosis deaths will occur in 1995 and 3.5 million in 2000. Demographic factors, such as population growth and changes in the age structure of populations, will account for 79.5% of the predicted increases in new cases. Age-specific incidence rates in sub-Saharan Africa are increasing due to the HIV epidemic and will account for the remaining 20.5% of the forecast increase in new cases. In WHO's South-East Asian Region and in Central and South America the age-specific incidence rates are expected to fall during 1990-2000, but at a slower rate than in previous years because of the expected increase in HIV seroprevalence.(ABSTRACT TRUNCATED AT 250 WORDS)

AIDS-Related Opportunistic Infections↗
PubMed1992

Occupation and bladder cancer: a death-certificate study.

Occupational statements on death certificates of 2,457 males aged 25-64 who died from bladder cancer in selected coastal and estaurine regions of England and Wales during 1965-1980 were studied. Excess mortality was found for deck and engine room crew of ships, railway workers, electrical and electronic workers, shoemakers and repairers, and tobacco workers. An excess of cases also occurred among food workers, particularly those employed in the bread and flour confectionary industry or involved in the extraction of animal and vegetable oils and fats. Use of a job-exposure matrix revealed elevated risk for occupations in which most workers were exposed to paints and pigments, benzene and cutting oils.

Adult↗